Background: Self-rated health (SRH) is among the most frequently assessed health perceptions in epidemiological research. While the predominant focus has been the predictive relevance of SRH, there is increasing interest in understanding the nature of SRH. Recently a conceptual interpretation of SRH was proposed. Purpose: To assess the tenability of the recently proposed distinctions of self-rated health, as a spontaneous assessment of overall health, or as an enduring self-concept, or both, and to determine the significance of mental well-being, physical and social health for SRH. Methods: A cohort of individuals undergoing total joint replacement (TJR) for hip or knee osteoarthritis (OA) was followed over 6 months of recovery. Participants (n=449) completed (pre-surgery, 3 and 6 months post-surgery) measures associated with physical health: pain, physical function, sports/recreation, fatigue; mental well-being: anxiety, depression; and social health: social participation, passive/active recreation, community access. Using structural equation modeling, confirmatory factor analyses (CFA) investigated 3 latent health variables, and the responsiveness of SRH to current and changing health status, as well as its predictive significance for future health status was investigated. Results: CFA analyses confirmed relationships between observed health measures and hypothesized latent health dimensions. SRH was responsive to current and changing mental well-being. The effects of physical and social health were mediated through mental well-being. SRH was a strong predictor of future SRH and future health status. Conclusion: SRH displayed features of both an enduring self-concept and spontaneous assessment of health status; evidence is provided that both operate simultaneously. While aspects of physical health have always been perceived as the major determinants of SRH, these findings indicate that mental and social health explain much of the relationship between physical health and SRH. These results are particularly unexpected since this is a sample of individuals undergoing TJR surgery, for which pain and restricted physical function are primary indicators. Since SRH is a significant predictor of health status, TJR outcomes, health care utilization and mortality, this study suggests that health research and care, treatment and management modalities should consider a broad range of health dimensions, not only physical aspects of health, and SRH.

Along with the numerous physical benefits of exercise, past research has shown that physical activity can alleviate symptoms of anxiety and depression in both clinical and non-clinical populations. Yet, it has been suggested less than half of American adults exercise at public health recommended levels. Therefore, it is important to identify factors that may lead to an increase in physical activity and, subsequently, improvements in mental health. Previous research, for the most part, has neglected to investigate how preference for attentional focus strategy during exercise influences mood. In addition, previous studies that involved attentional focus and exercise have focused more on participant’s resulting performance than affect. Therefore, the purpose of this study was to determine whether or not preference for attentional focus strategy would moderate the amount of affective change and enjoyment experienced during and after exercise. Participants (N=100) were recruited from psychology courses at Western Kentucky University. They were asked to run on a treadmill for 20 minutes on two separate days, one week apart. On one of the days they were asked to engage in their most preferred attentional focus strategy and another day their least preferred attentional focus strategy. The order of these sessions was counterbalanced. Participant’s preference for attentional focus strategies was used as an independent variable. The first dependent variable of interest was changes in affect, measured by the Activation-Deactivation Adjective Checklist (AD-ACL). The second dependent variable of interest was enjoyment, measured by the interest/enjoyment subscale of the Intrinsic Motivation Inventory (IMI). A 2 (Preference Condition) X 4 (Time) ANOVA was conducted for affect. There were no significant main effects and no significant interactions for preference. Yet, there was a significant change in affect across time. A one way ANOVA was conducted on enjoyment and autonomy levels. There were no significant main effects for preference. Results of the study indicated preference for attentional focus strategy does not influence the level of affective benefits typically associated with exercise, nor does it influence perceived enjoyment and autonomy. In addition, the study indicated individuals acquire affective benefits from engaging in moderate intensity exercise regardless of attentional focus strategy. Following from the findings of the current study, it is suggested that researchers continue to identify factors of the exercise experience that may lead to an increase in physical activity and, subsequently, improvements in mental health.

This study investigates how socially and economically disadvantaged young people, living in a semi-rural, post-industrial Atlantic Canadian community, experience and perceive social and economic health -- defined as participants' sense of comfort and security that their social and economic needs are, and will continue to be, met in their community. I argue that social and educational policies and practices must reflect the realities of local citizens if they aim to interrupt regional health disparities. A key objective of this research is to expose and challenge gender, class, and regional inequalities through an analysis of young adults' social and economic health experiences and perceptions. Drawing primarily upon Pierre Bourdieu's (1990b; 2001)concepts -- habitus, field, and symbolic domination -- relations between gender, class,and historical circumstances theoretically inform this research. Employing a critical ethnographic methodological framework (Madison, 2005),experiences and perceptions of ten economically disadvantaged youth -- five women and five men, ages 19-30 -- were gathered through focus groups, individual interviews, participant observation, critical dialogue (using media to stimulate dialogue among participants), and an adaptation of photovoice (a technique combining photography and narrative). Results suggest that the social and economic health needs of economically disadvantaged young adults are not being met. They confirm Bourdieu's (1999a)assertion of an interrelationship between physical place and the positioning of agents in social fields. Participants navigate economic, cultural, and social fields, aware of their social positioning as they 'work' the fields in order to secure enough capital to 'get by'. Their struggles are examples of symbolic domination and suggest a significant psycho-social cost to young adults seeking social and economic health through various fields. Analyses of their experiences suggest a disjuncture between gendered identities ascribed to participants through historically-rooted habitus and contemporary social fields. Recommendations call for gender, class, and regional inequalities to be addressed through structural interventions and investment in long term community-based education that is integrated with local economic development initiatives. Furthermore, this research calls attention to how research agendas and procedures can actually reinforce marginalization, making it difficult for the voices of disadvantaged communities to enter into dominant public discourse.

Depressive symptoms are common in patients with heart failure (HF) and adversely affect mortality, morbidity, and health-related quality of life. Cognitive therapy (CT) has been proposed as a non-pharmacological treatment for depressive symptoms in patients with HF. However, there is currently little evidence to support use of CT in patients with HF. The purpose of this dissertation was to develop and test a brief, nurse-delivered CT intervention for the treatment of depressive symptoms in patients with HF. Prior to testing the intervention, preliminary work was conducted resulting in four manuscripts: 1) a review of the evidence for CT in treating depressive symptoms in patients with cardiovascular conditions, 2) a description of living with depressive symptoms in patients with HF and strategies that could be used to manage these symptoms, 3) a review of measures of negative thinking and the identification of a measure of negative thinking that can be used in patients with HF, and 4) an evaluation of the psychometric properties of this measure. Based on information from these manuscripts, a randomized, controlled pilot study was conducted to test the effects of a brief CT intervention on outcomes of hospitalized patients with HF who report depressive symptoms. Forty-two hospitalized patients with HF with mild-moderate depressive symptoms were randomized to a brief CT intervention focused on reducing negative thoughts with thought-stopping and affirmations, or to usual care control. Both groups experienced improvements in depressive symptoms, health-related quality of life, and negative thinking at one week and three months. However, the intervention group experienced longer cardiac event-free survival and fewer cardiovascular hospitalizations and emergency department visits at three months when compared to the control group. This dissertation has fulfilled an important gap in the evidence base for depression treatment in patients with HF by demonstrating that a nurse-delivered, brief CT intervention may improve cardiac event-free survival in patients with HF. This brief CT intervention is replicable, practical, can be delivered by acute care nurses, and may improve clinical outcomes in patients with HF. Additional research is needed to determine the effects of the intervention on long-term outcomes in patients with HF.

<p> Human Immunodeficiency Virus (HIV) remains a serious public health issue, and many social factors are involved in virus transmission and treatment. The current conceptualization of how HIV status disclosure and perceived stigma of HIV diagnosis interact is undeveloped. This study was based on social cognitive theory and tested hypothesized positive relations between HIV serostatus disclosure, social support, and self-efficacy. In addition, self-rated HIV stigma was examined as a potential mediating variable. Participants were 109 HIV positive, mostly White gay men recruited via an online bulletin board. They completed the medical outcomes study social support survey, the general self-efficacy scale, the HIV stigma scale, a HIV serostatus disclosure questionnaire, and a demographic questionnaire. Linear regression revealed that social support significantly and positively predicted HIV serotatus disclosure. HIV stigma mediated this relation by lowering the perception of support. Sexual orientation disclosure significantly and positively predicted HIV serostatus disclosure and social support. It is recommended that future research examine the impact of HIV stigma in different groups (racial and sexual minorities, and women). Culturally-sensitive assessments may also be used to measure individual levels of perceived stigma, HIV status disclosure, and social support. Action for social change includes raising general public awareness regarding HIV misconceptions, such as transmission risk; lowering stigma and raising support through public education; and increasing sexual minority status self-identification via outreach in low self-disclosure communities.</p>

<p> <b>Background:</b> Dengue prevention for U.S. travelers focuses on compliance with mosquito avoidance practices (MAP) and passive surveillance. Understanding determinants of MAP among high-risk travelers can improve Dengue prevention strategies. In travel medicine, a risk assessment framework of social determinants of health and travel purpose of visiting friends and relatives (VFR) determines risk of travel-associated diseases. This risk assessment framework is subject to bias and inaccuracy because it fails to account for factors of influence on travel behaviors from a social-ecological perspective. A mixed methods approach identified and characterized determinants of MAP in U.S. West-Indian American VFR travelers. Two pilot studies revealed travelers' decision-making processes for MAP and outlined determinants of intended MAP through a qualitative interview and cross-sectional survey. Survey analyses included an exploratory factor analysis, Chi-squared/ Fisher's exact test, logistic regression and qualitative coding for development of an `Intended MAP International Travel Behavior' (IMAP-ITB) model. </p><p> <b>Methods:</b> To expand the IMAP-ITB model and describe factors of influence on actual MAP, 2 subsequent qualitative studies were conducted. A multi-case ethnographic study of travel cohorts to Trinidad, Brazil and Thailand identified social/physical environmental influences on actual MAP in a cross-case content analysis of field observations data. An interpretive phenomenological analysis of semi-structured interviews yielded similarities and differences in MAP by revealing the meaning of `going home' in VFR travelers versus another travel destination. </p><p> <b>Results:</b> A '<i>Cultural Embeddedness and MAP</i>' model extends the IMAP-ITB, using a social-ecological perspective, including factors of influence on intended and actual MAP. MAP during international travel was associated with travel logistics, social interactions, risk perceptions and cues to action. The concept of '<i>Cultural Embeddedness</i>' may explain compliance behaviors with MAP, irrespective of VFR status. </p><p> <b>Discussion:</b> Prevention strategies at each level of influence within a social-ecological framework would address Dengue emergence because individual level prevention using MAP is capricious by individual, type of travel and social/physical environmental influences. Findings demonstrate that VFR terminology does not accurately depict high-risk travelers. Next steps should include more research on the concept of '<i>Cultural Embeddedness </i>' and CEMAP. Furthermore, improvements to current Dengue surveillance are needed to prevent to prevent and monitor imported Dengue.</p>

<p> A spinal cord injury (SCI) can be debilitating and research is necessary to examine how patients' quality of life (QOL) can be improved through both psychological and physical remedies. This study's central research question was: Does participation in surfing improve perceptions of quality oflife in an individual with spinal cord injury? By interviewing eight individuals with SCis, the researcher attempted to assess, by means of a qualitative semi-structured interviews, whether participation in surfing activities had a positive impact on the respondents' perceived QOL. Respondents experienced improved QOL as a result of their participation in surfing with the Life Rolls On foundation because they felt supported, independent, relaxed, and exhilarated. Their perceived QOL was improved by the benefits of making friends and feeling like part of a community. It was hypothesized that respondents would report psychological benefits from recreational post-injury physical activities. These findings indicate support for the hypothesis.</p>

Thesis (Ph.D.)--Capella University, 2007. / (UMI)AAI3278060. Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 5890. Adviser: Kit Johnson.

Purpose: The purpose of this interpretive phenomenological study is to explore the lived experience of Haitian immigrant women living in Massachusetts with PPD. Specific Aims: Aim 1: To explore the lived experience of PPD among Haitian immigrant women. Aim 2: To explore how the experience of being Haitian influences Haitian immigrant women in their response to PPD. Framework: Leininger's Theory of Cultural Care (1988) guided the phenomenological approach and data collection. The Transcultural Care Decision & Action model contains three predictive modes for guiding nursing care judgments, decisions, or actions to provide care. Design: Interpretive phenomenology guided this qualitative study. Individual face-to-face interviews were conducted. The data from each interview were transcribed into a written document and analyzed using the Crist and Tanner five-step process. Results: This study yielded two themes; each theme has three dimensions. The first theme is “Feeling Disconnected” with three dimensions: (a) lack of support; (b) partner conflict; and, (c) nostalgia of Haiti. The second theme is “Feeling Reconnected” with three dimensions: (a) realization of needed help; (b) spirituality; and, (c) resilience. Conclusion: This study provides insight into the lived experience of Haitian women with PPD. Awareness of Haitian women’s actual experiences with PPD will help health care providers to identify and provide culturally appropriate care to this population.

This thesis deals with the mental and social health of adolescents in relation to their circadian rhythm. The theoretical part is focused on the fundamental insight into the problems of mental and social health, the definition and characterization of adolescence, the idea of circadian rhythms and sleep hygiene is also included. As for the research section, the default file survey was formed by 300 adolescents aged 15-18 years from secondary schools in České Budějovice in proportion of 150 girls and 150 boys. The average age of respondents was 16 years. Data were obtained under the project No. GAJU 101/2011/S "psychosocial and somatic parameters in comparison to the circadian rhythm" during the period September 2011 - March 2012. The method of research questions was formed by the selection of 2 standardized questionnaires. The questions of the concept of social quality of life questionnaire, Cummins (1997), ComQoL - S5 which was translated and adapted for the conditions of the Czech Republic. The issues related to the circadian rhythms are selected from the circadian typology questionnaire, CIT (Harada, Krejci, 2010). The data obtained were analyzed by using basic statistical methods and calculations.